Minimally Invasive Lateral Interbody Fusion

eXtreme Lateral Interbody Fusion (XLIF) and Direct Lateral Interbody Fusion (DLIF) are minimally invasive surgical procedures performed in patients with spinal instability caused by degenerative discs and/or facet joints that cause unnatural motion and pain, loss of height of the disc space between the vertebrae that causes pinching of the spinal nerves exiting the spinal canal, slippage of one vertebra over another, and/or changes in the normal curvature of the spine. The primary difference in these approaches is the area of the body through which the spine is accessed.

To access the anterior (front) spine and disc space, a 5-cm incision is made on the patient's side, usually with a second 2.5-cm incision just behind the first one. Special retractors are utilized, in addition to fluoroscopy, which provides intraoperative x-ray images of the spine. A tubular retractor or portal is passed and positioned along the lateral aspect of the vertebral bodies being operated upon.

Monitoring equipment is used to determine the placement of the instruments in relationship to the spinal nerves. Disc material is removed from the spine and replaced with a bone graft, along with structural support from a cage made of bone, titanium, carbon-fiber, or a polymer. This provides extra stability and helps the bone heal. Sometimes, surgeons will position small screws in the spine posteriorly through an additional procedure.

This procedure is limited to one or two levels, and only vertebra that can be clearly accessed from the side of the body can be operated on. This procedure typically takes about 1 to 1 ½ hours to perform.

Outcome
Because this is a fairly new procedure, there is very little long-term outcome data available. In general, there is very little blood loss with this procedure. Many patients are ambulatory within a few hours and discharged from the hospital the next day. Patients are often back to work within a few weeks.

American Association of Neurological Surgeons
Neurosurgerytoday.org
Minimally Invasive Spine Surgery, January 2009

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